positive emotions, assumptions, and actions may favorably influence parents’
coping and resilience when their child is ill.
healthcare service utilization in the following year (Thompson et al., 2017). The mental health of parents is also crucial for the treatment of a child’s illness.
Posttraumatic arousal and re-experiencing symptoms may interfere with a parent’s ability to understand medical instructions and communicate essential child health information to healthcare professionals (Kazak et al., 2004). On the one hand, hypervigilant parents may frequently contact medical services, which can lead to additional examinations and costs (Pelcovitz et al., 1998).
On the other hand, posttraumatic avoidance symptoms can cause parents to avoid necessary medical visits and procedures (Stuber et al., 1996). Arousal symptoms can cause parents to overprotect their children and restrict their participation in activities which disturb their normal development (Hoge et al., 2021; Santacroce, 2002). Posttraumatic stress disorder is associated with an increased risk of depression and substance abuse, which may also impair the parent’s ability to respond to the child’s emotional and developmental needs (Cabizuca et al., 2009).
2.3.2 Life satisfaction, posttraumatic growth, and resilience
Extensive research of families with a seriously ill child confirms that encountering adversity jointly can also strengthen parents’ well-being, the intimate relationship and family resilience. Parents whose child is experiencing pediatric medical traumatic stress have shown resilience (e.g., Gerhardt et al., 2007; Isokääntä et al., 2019; Muscara et al., 2018) and posttraumatic growth (PTG) (e.g., Barakat et al., 2006; Hungerbuehler et al., 2011; Picoraro et al., 2014). Resilience, in the broadest sense, refers to “dynamic processes that lead to adaptive outcomes in the face of adversity” (Lepore & Revenson, 2006). During the last decades, resilience has no longer been viewed just as an individual trait or skill, but also as an interactional process with its own specific qualities that are different from intrapsychic resilience (Rutter, 1999;
Walsh, 1996, 2011). In the context of long-term illness, Mullins et al. (2015, p. 182) defined resilience as “a process by which individuals learn to overcome the negative effects of risk exposure (e.g., the diagnosis and its treatment), cope with traumatic events (e.g., invasive medical procedures), and avoid negative trajectories of adjustment outcomes (e.g., increased uncertainty, depression, posttraumatic stress)”.
Calhoun and Tedeschi (1999, p. 1) defined PTG as “positive psychological change experienced as a result of a struggle with highly challenging life circumstances”. PTG’s components may include strengthening of social relations and appreciation of life, strength experience, new opportunities for life, and spiritual change (Tedeschi & Calhoun, 1996). PTG is related to social and psychological factors, such as a positive reinterpretation of a given situation (Aftyka, Rozalska-Walaszek, et al., 2017). Aftyka et al. (2020) found PTG among the parents with a hospitalized child. Fathers’ PTG is predicted by seeking emotional support, positive reinterpretation, and growth. In mothers, predictors of PTG include seeking emotional support, religious coping, and planning (Aftyka et al., 2020).
Life satisfaction can be defined as “a desired subjective feeling indicating general well-being” (Koivumaa-Honkanen et al., 2000, p. 983). Life satisfaction has been seen as a key component of health and well-being (Gilman &
Huebner, 2003). Although, no difference has been found in comparing the life satisfaction of ill or healthy children (Blackwell et al., 2019). Research concerning life satisfaction of parents with a somatically ill child is scarce.
In the study of Crespo et al. (2016), family-centered services were indirectly linked to better life satisfaction of parents of a child with cancer through a reduction in the burden of care.
2.3.3 Protective and risk factors
It is essential to understand the factors affecting the mental health of parents with an ill child in order to develop suitable, effective support forms and interventions. According to previous studies, demographic factors such as parents’ age, gender, education, ethnic background, and relationship status have not predicted the mental health of parents (Muscara et al., 2018).
Medical factors related to a child’s illness, such as the prognosis and the duration of hospitalization, have earlier been either not predictive or weak predictors of parents’ mental health effects (Kassam-Adams et al., 2009;
Rayner et al., 2016; Steele et al., 2004).However, new research has recently been published including more detailed information on the relationship between family characteristics, a child’s illness, and parents’ mental health. In a Finnish register-study Metsä-Simola et al. (2022) found that a child’s illness
clearly increased the use of parents’ psychotropic medication in the first year following the child’s diagnosis regardless of the cancer type, child’s age at diagnosis, and other family characteristics. Later, the nature and prognosis of the child’s illness influenced parents’ mental health so that the need for psychotropic medication was reduced during the follow-up in fathers, except those fathers whose child suffered from ALL or lymphoblastic lymphoma.
The medication needs of mothers of children with brain tumors remained elevated during the 5-year follow-up. Other factors that slowed down the recovery of mothers were the child diagnosed under 10 years of age and the existence of under-aged siblings (Metsä-Simola et al., 2022).
According to the studies so far, many psychosocial factors explain the variance of parental resilience and acute stress reactions (Muscara et al., 2018). For example, the parental conception of the severity of the child’s illness and the fear of losing the child are associated with their acute stress reactions (Bakker et al., 2012; Kassam-Adams et al., 2009). Mothers’
acute stress is related to the child’s young age, and fathers’ acute stress is associated with the severity of the child’s illness (Mortensen et al., 2015).
Previous miscarriages and chronic illnesses are risk factors reported for PTSD in mothers (Aftyka, Rybojad, et al., 2017). A mother’s PTSD is related to PTSD in fathers, and the seriousness of PTSD symptoms is associated with current stressors, previous anxiety, and depressive symptoms (Lefkowitz et al., 2010).
Parental anxiety symptoms are correlated with self-blaming, pessimism, illness-related uncertainty, and greater number of previous hospitalizations (Wray et al., 2011). Task-oriented coping strategies are related to higher resilience of parents (Ahn et al., 2014).
During the last decade, the dyadic processes underlying resilience and PTG have evoked growing scientific interest. These processes allow couples to cope with adversity and they promote strengthening by facing challenging situations together (Skerrett, 2015; Walsh, 2011). Social support and intimate relationship factors also contribute to partners’ individual well-being and coping. For example, couple therapy has favorably influenced partners’
mental health, functioning, and alcohol use (Seikkula et al., 2013). Tourunen et al. (2020) studied sympathetic nervous system synchrony in couple therapy and found that the therapy can bring partners closer on a physiological level,
which has appeared to be of particular importance to outcomes of therapy and especially to women’s well-being.
The support received from family members strengthens parental coping abilities (Nabors et al., 2013). A partner’s support is particularly meaningful in the crises represented by the child’s illness. For example, a high-quality intimate relationship is related to mental health in parents of children with cancer (Salvador et al., 2019). Dyadic coping is associated with parents’ well- being and experience of family adjustment soon after the diagnosis and over time (van Schoors, de Paepe, et al., 2019; van Schoors, Loeys, et al., 2019). Parents who have poorer relationship adjustment abilities following a diagnosis have more depressive symptoms, and their child and siblings have more emotional and behavioral problems (Alba-Suarez et al., 2020).
Consequently, couple resilience is central to both individual coping and family dynamics when a child is seriously ill. The couple resilience of the parents also has impacts on the child’s and siblings’ well-being and mental health.
2.4 The connections of a child’s serious illness to the